Dexamethasone vs methylprednisolone high dose for COVID-19 pneumonia

1. Hospitalized COVID-19 patients receiving high-dose methylprednisolone followed by oral prednisone had improved clinical outcomes compared to patients receiving dexamethasone.

Evidence Rating Level: 2 (Good)

In June 2020, a preliminary report of a study was published comparing hospitalized COVID-19 patients receiving dexamethasone (DXM) 6 mg daily (for 10 days) to patients who didn’t receive corticosteroids. The study found an 11% decrease in mortality for mechanically ventilated patients, and a 2.8% decrease in global mortality. However, it is unknown whether this effect is specific to dexamethasone, or if other corticosteroids would be effective. The current ambispective cohort study compared outcomes of patients on high-dose methylprednisolone (MTP) with those on DXM. This study was conducted at a centre in Colombia, where up until September 14, 2020, the protocol was to treat patients with DXM 6 mg daily for a maximum of 10 days (or until discharge). From September 15 onwards, the protocol changed to MTP 250-500 mg daily for 3 days, then oral prednisone 50 mg daily for 14 days. The cohort consisted of 216 patients, 111 of whom received DXM, and 105 receiving MTP. The results showed that 26.1% of patients in the DXM group developed severe acute respiratory distress syndrome (ARDS), compared to 17.1% in the MTP group. As well, there were lower rates of transfer to the ICU and mortality in the MTP group (4.8% versus 14.4% and 9.5% versus 17.1% respectively). Finally, clinical markers of COVID-19 severity were significantly lower in MTP patients, such as C-reactive protein (2.85, [95% CI 2.3-3.8] versus 7.2 [5.4-9.8], p < 0.0001), and D-dimer (691 [612-874] versus 1083 [740-1565], p = 0.04). Overall, the study found that patients receiving the high-dose methylprednisolone and prednisone treatments had better clinical outcomes than those receiving dexamethasone. However, randomized controlled trials would be needed to provide more robust evidence for this finding.

Click to read the study in PLOSONE

Image: PD

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